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Applicant Name: Name of Event: Contact Person: Phone # Mailing Address of Applicant: Location of Sales: Permit From To #of Calendar days x $30 = Fee Applicants that are receiving anything of value (i.e. money, goods and/or services) from any industry representative must answer the following: As an applicant for a 24-hour malt beverage permit, are you: A nonprofit corporation organized under the laws of this State YES NO Qualified as a tax exempt organization under the Internal Revenue Code YES NO Have been in continuous operation for not less than two years YES NO This application is for a malt beverage permit authorizing the sale of malt beverages only at public gatherings within the City of Cody (W.S. 12-4-502a). No person OR organization shall receive more than a total of 12 malt beverage permits at the same premises in any one year. No alcoholic liquor other than malt beverages may be sold or consumed on the premises authorized by this permit and no malt beverages may be sold or consumed off the premises. By filling out this application, I agree to operate in the City of Cody under the requirements of City Ordinances and W.S. 12-4-502 and all other applicable Wyoming laws and rules, and to file required sales tax reporting documents and remit sales taxes. Further, I acknowledge under penalty of perjury that all of the information provided in this application is true and correct. Signature of Applicant Date City of Cody Malt Beverage Permit Application